Questions & Answers Questions & Answers

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Parents of Children Parents of Children

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Attention Deficit DisorderAttention Deficit Disorder

What is Attention Deficit Disorder (ADD)?

How can I help my child?

How can I help my child succeed in school?

How can I be a better parent in order to help my entire family?

When parents are confronted with the possibility their child When parents are confronted with the possibility their child may suffer from Attention Deficit Disorder (ADD), there are may suffer from Attention Deficit Disorder (ADD), there are generally more questions than answers. This presentation generally more questions than answers. This presentation will help parents find answers to some general questions will help parents find answers to some general questions about ADD and their child. about ADD and their child.

What is Attention Deficit Disorder (ADD)?

As a parent, it is important to understand the clinical As a parent, it is important to understand the clinical definition of ADD. Questions that arise after this definition of ADD. Questions that arise after this understanding include:understanding include:

• How common is ADD?How common is ADD?

• Is there more than on kind of ADD?Is there more than on kind of ADD?

• How can I tell if my child has ADD?How can I tell if my child has ADD?

• How will a doctor or profession determine if my child has How will a doctor or profession determine if my child has ADD?ADD?

• Did I cause this to happen to my child?Did I cause this to happen to my child?

• What are some of the potential problems my child may What are some of the potential problems my child may face?face?

• Is it all bad news or does my child have some strengths?Is it all bad news or does my child have some strengths?

Attention Deficit Disorder as defined by the American Psychiatric Association is “…“…a persistent pattern of a persistent pattern of inattention, impulsivity, inattention, impulsivity, and/or hyperactivity-and/or hyperactivity-impulsivity that is more impulsivity that is more frequent and severe than is frequent and severe than is typically observed in typically observed in individuals at a comparable individuals at a comparable level of development”level of development” (Salend & Rohena, 2003, p. 260).

What is Attention Deficit Disorder (ADD)?

ADD is a psychiatric diagnosis rather than a separate disability category ADD is a psychiatric diagnosis rather than a separate disability category recognized by the Individuals with Disabilities Education Act (IDEA) recognized by the Individuals with Disabilities Education Act (IDEA) (Salend & Rohena, 2003). Children with ADD may qualify for special (Salend & Rohena, 2003). Children with ADD may qualify for special education services under the IDEA category of ‘other health education services under the IDEA category of ‘other health impairments’ (Turnbull, R., Turnbull A., Shank, Smith, & Leal, 2002). impairments’ (Turnbull, R., Turnbull A., Shank, Smith, & Leal, 2002). It is a brain disorder that may last a lifetime (Fell & Pierce, 1995).It is a brain disorder that may last a lifetime (Fell & Pierce, 1995).

The IDEA definition includes students

“having limited strength, vitality, or alertness, including a heightened alertness with respect to the education environment:

i. Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and

ii. Adversely affects a child’s educational performance” (34 Code of Federal Regulations §300.7(9)as quoted in Turnball et al., 2002).

The IDEA definition includes students

“having limited strength, vitality, or alertness, including a heightened alertness with respect to the education environment:

i. Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and

ii. Adversely affects a child’s educational performance” (34 Code of Federal Regulations §300.7(9)as quoted in Turnball et al., 2002).

How common is ADD?

• MillionsMillions of American children of American children have been diagnosed have been diagnosed with ADDwith ADD

• One of the One of the most frequentlymost frequently diagnosed disorders in diagnosed disorders in childhoodchildhood

• Perhaps affecting as much as Perhaps affecting as much as 20% of school age 20% of school age childrenchildren (Erk, 1995) (Erk, 1995)

• Most commonMost common neurological disorder of childhood neurological disorder of childhood (Erk, 1997)(Erk, 1997)

• 3.4 %3.4 % of adolescent girls have ADHD of adolescent girls have ADHD

• 7.3 %7.3 % of adolescent boys have ADHD (McCleary, of adolescent boys have ADHD (McCleary, 2003)2003)

Three types of ADDThree types of ADD

1.1. Inattention accompanied by hyperactivity (ADHD-HI or Inattention accompanied by hyperactivity (ADHD-HI or ADHD)ADHD)

2.2. Predominantly inattentive (ADD/IA), without Predominantly inattentive (ADD/IA), without hyperactivity (ADD/WO), or undifferentiated (UADD).hyperactivity (ADD/WO), or undifferentiated (UADD).

3.3. Combination of hyperactivity and distractibility Combination of hyperactivity and distractibility (ADHD-C)(ADHD-C)

Common characteristics:

“Their inattentiveness, disorganization, and poor motivation interfere with their learning and academic performance, their social interactions and friendships with others, and their emotional development” (Salend & Rohena, 2003, p. 261).

Common characteristics:

“Their inattentiveness, disorganization, and poor motivation interfere with their learning and academic performance, their social interactions and friendships with others, and their emotional development” (Salend & Rohena, 2003, p. 261).

Is there more than one kind of attention deficit disorder?

• Inattentive to work or play activitiesInattentive to work or play activities• Not listening when spoken toNot listening when spoken to• Not following directions at home or Not following directions at home or schoolschool

• Having problems with organizationHaving problems with organization• Being distractingBeing distracting• Moving or talking excessivelyMoving or talking excessively• Acting in an impulsive mannerActing in an impulsive manner• InterruptingInterrupting• Failure to take turns in play or conversationFailure to take turns in play or conversation

A cluster of these behaviors A cluster of these behaviors must be presentmust be present before the age of 7 before the age of 7

AndAnd interfereinterfere with the individuals social, education, and occupational with the individuals social, education, and occupational performance in two or more settingsperformance in two or more settings

AndAnd not be relatednot be related to other medical or psychiatric conditions to other medical or psychiatric conditions (Salend & Rowena, 2003)(Salend & Rowena, 2003)

How can I tell if my child has ADD?

Professional assessment is requiredProfessional assessment is required but behaviors to observe include: but behaviors to observe include:

A A multi-method, multi-factor, multi-disciplinarymulti-method, multi-factor, multi-disciplinary assessment process assessment process will be used to identify and assess students with ADD which may will be used to identify and assess students with ADD which may include:include:

• Behavior assessments, measurement of behavioral and social Behavior assessments, measurement of behavioral and social skills, functional behavioral assessmentsskills, functional behavioral assessments

• Student academic performance factorsStudent academic performance factors

• Consideration of cultural and linguistic factorsConsideration of cultural and linguistic factors

• Determination IDEA or Section 504 eligibility (Salend & Determination IDEA or Section 504 eligibility (Salend & Rohena, 2003)Rohena, 2003)

• Complete physical and neurological evaluation by a physician Complete physical and neurological evaluation by a physician (Schwiebert & Sealander, 1995)(Schwiebert & Sealander, 1995)

How will a doctor or other professional determine if my child has ADD?

Factors contributing to ADD:Factors contributing to ADD:

• Neurological conditionNeurological condition – multifaceted and the focus of on- – multifaceted and the focus of on-going research (Salend & Rohena, 2003); Brain going research (Salend & Rohena, 2003); Brain dysfunction but not brain damage (Erk, 1997)dysfunction but not brain damage (Erk, 1997)

• Biological factorsBiological factors – temperament (Salend & Rohena, – temperament (Salend & Rohena, 2003); Heredity (Erk, 1997)2003); Heredity (Erk, 1997)

• Environmental factorsEnvironmental factors – allergies, pre-, peri- and post- – allergies, pre-, peri- and post-natal carenatal care

• Experiential factorsExperiential factors – interaction with family and others, – interaction with family and others, cultural & economic background. (Salend & Rohena, cultural & economic background. (Salend & Rohena, 2003)2003)

• MalnutritionMalnutrition (Schwiebert & Sealander, 1995) (Schwiebert & Sealander, 1995)

Did I cause this to happen to my child?

• May develop May develop emotional, social, developmental, emotional, social, developmental, academicacademic and/or and/or family difficultiesfamily difficulties

• May result in May result in anger, aggression, depressionanger, aggression, depression or or anxietyanxiety

• At risk for At risk for dropping out of schooldropping out of school

• At risk for At risk for alcohol and/or drug abusealcohol and/or drug abuse

• Increased risk for Increased risk for delinquency delinquency (Schwiebert & (Schwiebert & Sealander, 1995)Sealander, 1995)

What are some of the potential problems my child may face?

Is it all bad news or does my child have some strengths?

Strengths of children with ADD:Strengths of children with ADD:

VisualizationVisualizationVitalityVitalityCreativityCreativity

Activity (Armstrong, 1966)Activity (Armstrong, 1966)

• Winston ChurchillWinston Churchill

• Florence NightingaleFlorence Nightingale

• Charles DarwinCharles Darwin(Armstrong, 1996)(Armstrong, 1996)

Many famous and very successful individuals may have suffered Many famous and very successful individuals may have suffered from ADD. These include names such as:from ADD. These include names such as:

• Thomas EdisonThomas Edison

• Pablo PicassoPablo Picasso

• Friedreich NietzscheFriedreich Nietzsche

How can I help my child?

What is a holistic approach to ADD?

What are some common interventions I can expect for my child with ADD?

Once a child has been Once a child has been diagnosed with ADD, diagnosed with ADD, parents may ask many parents may ask many questions including the questions including the following:following:

• Your Your most important rolemost important role is that of a is that of a parentparent. Enjoy your child. . Enjoy your child. Provide Provide close and lovingclose and loving support. Your involvement can reap support. Your involvement can reap tremendous educational benefits for your child. tremendous educational benefits for your child. Share information, Share information, become an expert observer and communicatebecome an expert observer and communicate with key personnel with key personnel (Fell & Pierce, 1995). (Fell & Pierce, 1995).

• Seek helpSeek help. Parent training can help you help your child reduce . Parent training can help you help your child reduce activity level, minimize conflict and anger intensity,activity level, minimize conflict and anger intensity, and and increase on-increase on-task behaviortask behavior. Increased parenting skills can have a . Increased parenting skills can have a positive effectpositive effect on the behavior of your child (Erk, 1997).on the behavior of your child (Erk, 1997).

• Employ a holistic approach focusing on Employ a holistic approach focusing on internal empowermentinternal empowerment rather than rather than external controlexternal control. Help your child discover their . Help your child discover their inner inner resourcesresources through a combination of strategies. We know what kids through a combination of strategies. We know what kids ‘can’t’ do‘can’t’ do. We need to . We need to focus on what they ‘can’ dofocus on what they ‘can’ do (Armstrong, (Armstrong, 1996). 1996).

How can I help my child?

Possible Holistic Approaches:Possible Holistic Approaches: CognitiveCognitive – use focusing and attention training – use focusing and attention training

techniques including biofeedback, organizational techniques including biofeedback, organizational strategies, etc.strategies, etc.

EcologicalEcological – – limit televisionlimit television, use music and art, good diet, use music and art, good diet PhysicalPhysical – strong physical education program – strong physical education program EmotionalEmotional – – build self-esteembuild self-esteem BehavioralBehavioral – use contracting, – use contracting, immediate feedbackimmediate feedback, ,

natural logical consequences, etc.natural logical consequences, etc. SocialSocial –teach –teach effective communication skillseffective communication skills, social skills, , social skills,

peer tutoring, cooperative learning, etc.peer tutoring, cooperative learning, etc. EducationalEducational – use computers, hand-on learning, multiple – use computers, hand-on learning, multiple

intelligences, develop creativity (Armstrong, 1996)intelligences, develop creativity (Armstrong, 1996)

What is a holistic approach to ADD?

Behavioral and social interventions – class environment, tasks, novelty and stimulation on repetitive tasks, improved task structure such as shape, color and texture, smaller class sizes, direct instruction, peer mediation, time-out, token economy (rewards) (Schwiebert & Sealander, 1995).

Educational interventions (Salend & Rohena, 2003) Cognitive interventions such as problem solving, teaching cognitive strategies, self monitoring, bibliotherapy (Schwiebert & Sealander, 1995)

Pharmacological interventions, possibly Ritalin, Dexedrine, or Cylert (Schwiebert & Sealander, 1995)

Home-School partnerships with families (Salend & Rohena, 2003)

What are some common of interventions I can expect for my child with ADD?

What are some specific educational interventions for children with ADD that I may suggest for my child’s teacher?

What are some strategies I can use at home to help my child succeed in school?

How can I be a good advocate for my child?

Concerned parents of Concerned parents of children diagnosed with children diagnosed with ADD must learn to adapt ADD must learn to adapt to an education system to an education system that may require parental that may require parental involvement. Frequently involvement. Frequently asked questions include:asked questions include:

Educational interventions - Educational interventions - TGIF model is often effective for ADD TGIF model is often effective for ADD students:students:

TTeacher-directed instruction – high rates of active student eacher-directed instruction – high rates of active student engagement, fast-paced lessons, immediate and positive feedback; engagement, fast-paced lessons, immediate and positive feedback; and correction procedures for student errors – Some specific and correction procedures for student errors – Some specific techniques include asking frequent questions, an on-task chart, and techniques include asking frequent questions, an on-task chart, and social skills education such as following instructionssocial skills education such as following instructions

GGuided practice activities – teacher leads and prompts students uided practice activities – teacher leads and prompts students through structured activitiesthrough structured activities

IIndependent practice activities – Teacher provides fewer prompts ndependent practice activities – Teacher provides fewer prompts and less guidance to build fluency and generalize informationand less guidance to build fluency and generalize information

FFinal measurement – End-of-unit performance assessment – with inal measurement – End-of-unit performance assessment – with continuous measurement of student understanding throughout the continuous measurement of student understanding throughout the unit (Kemp & Fister, 2003)unit (Kemp & Fister, 2003)

What are some specific educational interventions for children with ADD that I may suggest for my child’s teacher?

• ADD students need ADD students need structured daily schedulesstructured daily schedules with with opportunities for movementopportunities for movement

• Strategies Strategies must bemust be interesting relevant, motivatinginteresting relevant, motivating, and , and multisensorymultisensory

• EncourageEncourage active participation, interaction with others, active participation, interaction with others, and choices incorporating learning styles and strengthsand choices incorporating learning styles and strengths

• Use graphic organizersUse graphic organizers; Allow students to write their ; Allow students to write their own books (Ostoits, 1999)own books (Ostoits, 1999)

• EncourageEncourage students to students to interact with classmatesinteract with classmates during during assignments and when possible assignments and when possible involve family members, involve family members, peers, and communitypeers, and community (Church et al., 2003) (Church et al., 2003)

What are some specific educational interventions for children with ADD that I may suggest for my child’s teacher? (Con’t.)

Use Use simplesimple, , noncompetitive gamesnoncompetitive games

HelpHelp students recognize students recognize non-verbal language and non-verbal language and unwritten rulesunwritten rules to enhance social and friendship skills to enhance social and friendship skills

Set Set behavior goals, acknowledge and comment on behavior goals, acknowledge and comment on appropriate behavior, and offer rewardsappropriate behavior, and offer rewards that that fosterfoster cooperation and social interactioncooperation and social interaction

HelpHelp students learn to evaluate the effectiveness of their students learn to evaluate the effectiveness of their social strategies and help clarify rules social strategies and help clarify rules

EncourageEncourage students to develop outside interests students to develop outside interests

EncourageEncourage sharing of concerns (Church et al., 2003) sharing of concerns (Church et al., 2003)

What are some specific educational interventions for children with ADD that I may suggest for my child’s teacher? (Con’t.)

Be a partnerBe a partner in your child’s education in your child’s education HelpHelp your child see how they are your child see how they are different from and are different from and are

similarsimilar to others to others HelpHelp them learn to them learn to handle criticism constructivelyhandle criticism constructively Develop an understanding of their Develop an understanding of their strengths and strengths and

weaknessesweaknesses HelpHelp your child develop study your child develop study skills and learning strategiesskills and learning strategies

to foster cognitive and social-emotional growthto foster cognitive and social-emotional growth HelpHelp children understand they are not alone in the children understand they are not alone in the

problemproblem HelpHelp your child your child face challengesface challenges and maximize their and maximize their

potential (Fouse & Morrison, 1997)potential (Fouse & Morrison, 1997)

What are some strategies I can use at home to help my child succeed in school?

1.1. DevelopDevelop your your advocacy skillsadvocacy skills

2.2. UnderstandUnderstand that families of children with ADD are that families of children with ADD are vulnerable to stressvulnerable to stress

3.3. Avoid jargon – Avoid jargon – ask for explanationsask for explanations if you don’t if you don’t understand what is being saidunderstand what is being said

4.4. AttendAttend all all meetings and conferencesmeetings and conferences to expand your to expand your knowledge and support your child’s learning and include knowledge and support your child’s learning and include all important family and caregivers in decisions and all important family and caregivers in decisions and strategiesstrategies

5.5. SeekSeek strategies for managing your child’s behaviorstrategies for managing your child’s behavior – he or – he or she is not misbehaving to be malicious! (Mathur & Smith, she is not misbehaving to be malicious! (Mathur & Smith, 2003) 2003)

How can I be a good advocate for my child?

6. 6. NetworkNetwork with other families and with other families and use the internetuse the internet to to get current information about ADDget current information about ADD

7. Use a 7. Use a dialogue notebookdialogue notebook between home and school between home and school

8. Be prepared to 8. Be prepared to mend fencesmend fences (Mathur & Smith, (Mathur & Smith, 2003)2003)

9. 9. Don’t isolateDon’t isolate yourself from yourself from family and friendsfamily and friends because of difficulties with ADD because of difficulties with ADD

10. 10. Believe in yourselfBelieve in yourself – you are a good parent! – you are a good parent! (McCleary, 2002)(McCleary, 2002)

How can I be a good advocate for my child? (con’t.)

I’m feeling so stressed. Is this normal?

What can I do about the stress I’m feeling?

What kind of help is available to me as a parent?

How can I help be a better parent in order to help my entire family?

Parents with an ADD Parents with an ADD child must understand child must understand their need for assistance their need for assistance and support. and support. Frequently asked Frequently asked questions include:questions include:

Stressors faced by parents of ADD children:Stressors faced by parents of ADD children:

• Parent factors such as Parent factors such as health, depression, sense health, depression, sense of competence, personality, and psychopathologyof competence, personality, and psychopathology

• Child factors such as Child factors such as adaptability, acceptability, adaptability, acceptability, demandingness, mood, hyperactivitydemandingness, mood, hyperactivity

• Socio-economic factors such as Socio-economic factors such as parent role parent role restrictions, spousal relationship, and social restrictions, spousal relationship, and social supportsupport

• Parent and child conflict is determined by all Parent and child conflict is determined by all three of the above (McCleary, 2002)three of the above (McCleary, 2002)

I’m feeling so stressed. Is this normal?

Problem focused copingProblem focused coping

• Learning about ADHD, Learning about ADHD,

• Learning about Learning about child child development and parent-development and parent-child relationshipschild relationships

• Restricting the child’s Restricting the child’s activityactivity

• ArguingArguing

• Working to change school Working to change school expectations (McCleary, expectations (McCleary, 2002)2002)

Problem focused copingProblem focused coping

• Learning about ADHD, Learning about ADHD,

• Learning about Learning about child child development and parent-development and parent-child relationshipschild relationships

• Restricting the child’s Restricting the child’s activityactivity

• ArguingArguing

• Working to change school Working to change school expectations (McCleary, expectations (McCleary, 2002)2002)

Emotion focused coping:Emotion focused coping:

• Time apartTime apart

• Venting Venting frustrationsfrustrations

• ReappraisingReappraising situation as situation as less stressful (McCleary, less stressful (McCleary, 2002)2002)

Emotion focused coping:Emotion focused coping:

• Time apartTime apart

• Venting Venting frustrationsfrustrations

• ReappraisingReappraising situation as situation as less stressful (McCleary, less stressful (McCleary, 2002)2002)

What can I do about the stress I’m feeling?

Coping is what parents do Coping is what parents do to manage stressors – based to manage stressors – based on your resources and how on your resources and how

well you can use themwell you can use them

Parent education and/or counseling about dealing with your Parent education and/or counseling about dealing with your ADD child may:ADD child may:

ImproveImprove your ability to make your ability to make treatment decisionstreatment decisions

ImproveImprove confidenceconfidence

CorrectCorrect misperceptions about ADHD/provide information misperceptions about ADHD/provide information

ChangeChange negative attitudes about behaviornegative attitudes about behavior

ProvideProvide training on training on problem solving, communication and problem solving, communication and conflict resolutionsconflict resolutions

EmpowerEmpower you to establish you to establish support groupssupport groups

EncourageEncourage you to increase you to increase social support networkssocial support networks

ImproveImprove coping skills (McCleary, 2002) coping skills (McCleary, 2002)

What kind of help is available to me as a parent?

PARENTS AND TEACHERSPARENTS AND TEACHERS

As you deal with ADD students and children, take the As you deal with ADD students and children, take the advice of Sir Winston Churchill:advice of Sir Winston Churchill:

““NEVER, NEVER, NEVER NEVER, NEVER, NEVER GIVE UP!”GIVE UP!”

What is Attention Deficit Disorder (ADD)?What is Attention Deficit Disorder (ADD)?http://www.nimh.nih.gov/

Barkley, R.A. (1990). Barkley, R.A. (1990). Attention-deficit hyperactivity disorder: A handbook for diagnosis and Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatmenttreatment. New York: Guildford Press.. New York: Guildford Press.

How can I help my child? How can I help my child? http://www.chadd.org/

Crock, W. (1991). Crock, W. (1991). Help for the hyperactive childHelp for the hyperactive child. Jackson, TN: Professional Books.. Jackson, TN: Professional Books.

How can I help my child succeed in school?How can I help my child succeed in school?http://www.add.org/

Parker, H.C. (1992). Parker, H.C. (1992). The ADD hyperactivity handbook for schools.The ADD hyperactivity handbook for schools. Plantation, FL: Impact Plantation, FL: Impact Publications.Publications.

How can I help I be a better parent in How can I help I be a better parent in

order to help my entire familyorder to help my entire family??http://www.adhd.com/

Anderson, S. (2001). ADHD and the role of parents. Anderson, S. (2001). ADHD and the role of parents. Drug Benefit TrendsDrug Benefit Trends, 13, 21-24., 13, 21-24.

Helpful web sites and references for additional answers to your Helpful web sites and references for additional answers to your questions.questions.

References

Armstrong, T. (1996). A holistic approach to attention deficit disorder. Educational Leadership, 53(54), 34-36.

Church, K., Gottschalk, C. M. & Leddy, J.N. (2003). Enhance social and friendship skills. Intervention in School & Clinic, 38(5), 307-310.

Erk, R. R. (1995). The evolution of attention deficit disorders terminology. Elementary School Guidance & Counseling, 29(4), 243-249.

Erk, R. R. (1997). Multidimensional treatment of attention deficit disorder: A family oriented approach. Journal of Mental Health Counseling, 19(1), 3-23.

Fell, B. & Pierce, K. (1995). Meeting the ADD challenge: A multimodal plan for parents, students, teachers and physicians. Intervention in School and Clinic, 30(4), 198-202.

Fouse, B & Morrison, J. A. (1997). Using children’s books as an intervention for attention deficit disorder. The Reading Teacher, 50(5), 442-445.

Kemp, K. & Fister, S. (1995). Academic strategies for children with ADD. Intervention in School & Clinic, 30(4), 203-210.

References (continued)

Mann, S. (1996). The ADD strategies worksheet. School Counselor, 44(2), 155-158.

Mathur, S. & Smith R. M. (2003). Collaborate with Families of Children with ADD. Intervention in School and Clinic, 38(5), 311-315.

McCleary, L. (2002). Parenting adolescents with attention deficit hyperactivity disorder. Health and Social Work, 27(4), 285-292.

Ostoits, J. (1999). Reading strategies for students with ADD and ADHD in the inclusive classroom. Preventing School Failure, 43(3), 129-132.

Salend, S. J. & Rohena, E. (2003). Students with attention deficit disorders: An overview. Intervention in School and Clinic, 38(5), 259-266.

Schwiebert, V. L. & Sealander, K. A. (1995). Attention deficit hyperactivity disorder: An overview for school counselors. Elementary School Guidance and Counseling, 29(4), 249-261.

Turnbull R., Turnbull A., Shank, M., Smith, S., & Leal, D. (2002). Exceptional lives: Special education in today’s schools (3rd ed.). Upper Saddle River, NJ: Pearson Education, Inc.